1. Field of the Invention
This invention relates to the fields of psychology and acupuncture and specifically to a device to aid a person in quitting cigarette smoking.
2. Discussion of Related Art
Cigarette smoking is a particularly tenacious addiction. As contrasted to use of illegal drugs, smoking is tolerated in a variety of every day situations. Thus the smoker has the unfortunate opportunity to integrate cigarette usage into virtually every aspect of his daily life.
The addicted smoker develops strong psychological dependencies and habit patterns that remain for many months after nicotine is eliminated from the body. Therefore, quitting smoking is considerably more difficult than simply ridding the body of nicotine.
The physical dependency to nicotine has a strong psycho-pharmacological basis. Yet surprisingly, nicotine has a half life of just two hours and its principal metabolite, cotinine, has a half life of three to nineteen hours [see Benowitz, N. (1983) "The Use of Biologic Fluid Samples in Assessing Tobacco Smoke Consumption" in NIDA Research Monograph #48; U.S. Department of Health and Human Services. pp. 6-26]. In general, 24 to 48 hours are required for nicotine to be completely eliminated from the body and approximately two weeks for metabolic and other components to be eliminated. Thus, a treatment adjunct that can and will be used for long periods of time after the physical components of the addiction subside is highly desirable.
Most researchers in the field report that the highest success rates for quitting smoking involve the use of a number of treatment modalities. With the exception of dying from cigarette smoking related causes, there is no sure-fire single method of quitting smoking.
Pharmacological adjuncts have been employed to treat the physical addiction to nicotine. Among these, nicotine polacrilex (gum) has been used in several clinical and self-management programs. In terms of the gum's efficacy, Brown and Emmons (1991) report that "it may be more effective in increasing short-term abstinence, rather than long term outcome." [Brown, R. A. and K. M. Emmons (1991). "Behavioral Treatment of Cigarette Dependence" in The Clinical Management of Nicotine Dependence. J. A. Cocores, ed.; Springer-Verlag. New York. p.110]. Recent research has demonstrated that a similar argument could be made for the nicotine "patch" if on-going behavioral modification is not incorporated as a treatment adjunct.
A review of a variety of aversion therapy techniques is given by Smith (1991) [in The Clinical Management of Nicotine Dependence. J. A. Cocores, ed.; Springer-Verlag. New York pp. 135-149]. Among short term techniques that have been used are focused smoking, rapid smoking, taste aversion, faradic (electric) shock, and covert sensitization. In general, these techniques have been employed during and immediately after the period in which the smoker is still physically addicted to nicotine and with the possible exception of covert sensitization are not appropriate for use on a long-term basis. Faradic shock has been employed in a number of clinical treatments and is a part of the short-term treatment paradigm used by the Schick Center. Symmes, [U.S. Pat. No. 3,885,576], disclosed a device comprising a wrist band with a mercury switch that induces an electric shock when the user raises his hand to (ostensibly) bring a cigarette to his lips. This and other conceptually similar devices have an inherent drawback when used to curb cigarette addiction. For example, Powell and Azrin (1968) in a study of self-administered electric shock to limit cigarette intake, found that the greater the shock intensity the less time the subjects tended to use the device [Powell, J. R. and N. Azrin. (1968) Appl. Behav. Anal. Vol 1, p.63-71]. The authors concluded that the subjects developed an aversion to the shock technique itself, which would suggest a limitation to its long term utility. In other words, it is doubtful that users would employ such a device on a self-administered basis after the physical dependency stage of cigarette addiction is over.
Use of a wrist-worn rubber band has been suggested by Glynn and Manley (1976) as one of a number of behavioral-modification techniques to aid smokers in quitting [Glynn, T. and M. Manley. (1976) National Cancer Institute Manual For Physicians. U.S. Dept. of Health and Human Services. p.46]. The authors suggest that the band be snapped each time the smoker wants a cigarette and be accompanied by the smoker imagining a stop sign and repeating the word "stop" in his mind.
The foremost drawback of a wrist-worn rubber band for curbing cigarette addiction is that a rubber band is highly extensible and therefore the user can self-inflict considerable pain and erythema depending upon how aggressively he "snaps" the band. As the research of Powell and Azrin suggests, the user may very likely develop an aversion to the rubber band's "sting" and cease its use. On the other hand a wrist band especially designed to limit the maximum "sting" to an acceptably low level may very well enhance the "snap" technique's efficacy for long-term behavior modification due to its acting as an associative agent rather than an aversive therapy device.
Another drawback to the use of a wrist-worn rubber band as described above is that the rubber band has low face validity to the user as a treatment device. The very fact that the band has ubiquitous uses and is essentially cost-free, may lower its perceived potential effectiveness in the user's mind.
A third drawback of the wrist-worn rubber band is that it is not adjustable.
Acupuncture has been used to treat a variety of drug dependencies including cigarette addiction. For treatment of nicotine addiction Kutchins (1991) prescribes stimulation of the L-7 (Lieque) acupuncture point (proximal to the wrist crease) and lung points of the ear [Kutchins, S. (1991) "The Treatment of Smoking and Nicotine Addiction with Acupuncture" in The Clinical Management of Nicotine Dependence. J. A. Cocores, ed.; Springer-Verlag. New York pp. 169-180]. He reports that in some cases stimulation of L-7 alone is sufficient in that stimulation of the lung points of the ear tend to replicate L-7 in treatment of the addiction. As with more traditional approaches, Kutchins recommends that acupuncture be a part of a multi-faceted approach to treatment. Kutchins reports that use of acupuncture is efficacious and supported by clinical evidence--especially in the short term context.
Olms (1984) reports the use of the "Tim Mee" acupuncture point for the treatment of smoking addiction. This point is located proximal to L-7 but more dorsally on the wrist. Olms reports that stimulation of the Tim Mee point reduces the desire to smoke and suppresses coughing. [Olms, J. (1985). Intl. J. Chinese Medicine, 2:2, pp 33-36.].
Isaacson [U.S. Pat. No. 4,479,495] discloses an acupressure point stimulator mounted to an adjustable strap for use in stimulating acupuncture points on the limbs. In use, an appropriate stimulator is positioned over the desired acupuncture point and the strap tightened so as to exert force on the region of the desired point. When used on a lower extremity, limb movement (for instance, walking) provides constant and differential stimulation to the chosen point. However, if the device is used on the lower arm, no such differential stimulation will occur during normal arm movement.
It should be noted that the L-7 acupuncture point (and to a lesser degree, the Tim Mee point) is located proximal to the radial artery, cephalic vein and various nerves. It is therefore prudent that a strong continuous force against the L-7 region be avoided. Such reasoning would argue against a device (such as in Isaacson) that is intended to be purposely cinched down so as to specifically apply constant force against the L-7 region.
What is needed is a device which is simple and economical to fabricate and to use, is not subject to the disadvantages mentioned hereinabove with respect to the prior art approaches to solving the problem, and which is effective as an aid to breaking the smoking habit. The present invention combines the treatment modalities of a "snappable" wrist band with limited "sting potential" and an L-7 acupuncture point stimulator. This treatment combination is advantageously made possible by the proximity of acupuncture point L-7 to the wrist crease. To the extent that the Tim Mee acupuncture point is an effective alternative to L-7 and in light of the proximity of the Tim Mee point to L-7, the embodiments disclosed herein apply to the Tim Mee point as well.